ArticleInternational journal for equity in health2015
Unexplained health inequality--is it unfair?
Article in International journal for equity in health, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Causal Inference in Health Disparities Research.Annual review of public health · 2026Review
- What role does social class play in the impact of social environment on residents' health.Scientific reports · 2025Article
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- Equal Opportunity and Luck: Empirical Exploration Using the Canadian Longitudinal Study on Aging.Social indicators research · 2025Article
- Decomposing the inequalities in the catastrophic health expenditures on the hospitalization in India: empirical evidence from national sample survey data.Frontiers in public health · 2024Article
- The Effect of Ecological Management on Regional Health Inequality.International journal of environmental research and public health · 2023Article
- Horizontal inequity in self-reported morbidity and untreated morbidity in India: Evidence from National Sample Survey Data.International journal for equity in health · 2021Article
- Horizontal inequity in the utilization of cataract surgery in Iran: Shahroud Eye Cohort Study, 2009-2014.Medical journal of the Islamic Republic of Iran · 2019Article
- Measuring and Visualizing Chlamydia and Gonorrhea Inequality: An Informatics Approach Using Geographical Information Systems.Online journal of public health informatics · 2019Article
- Health inequalities and inequities by age: Stability for the Health Utilities Index and divergence for the Frailty Index.SSM - population health · 2018Article
- Using Cost-Effectiveness Analysis to Address Health Equity Concerns.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2017Article
- Assessment of Horizontal Inequity in Eye Care Utilization in the Iranian Middle-aged Population.Journal of ophthalmic & vision researchArticle
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Authors and funding
4 authors.
Funding
Abstract
introductionAccurate measurement of health inequities is indispensable to track progress or to identify needs for health equity policy interventions. A key empirical task is to measure the extent to which observed inequality in health - a difference in health - is inequitable. Empirically operationalizing definitions of health inequity has generated an important question not considered in the conceptual literature on health inequity. Empirical analysis can explain only a portion of observed health inequality. This paper demonstrates that the treatment of unexplained inequality is not only a methodological but ethical question and that the answer to the ethical question - whether unexplained health inequality is unfair - determines the appropriate standardization method for health inequity analysis and can lead to potentially divergent estimates of health inequity.
methodsWe use the American sample of the 2002-03 Joint Canada/United States Survey of Health and measure health by the Health Utilities Index (HUI). We model variation in the observed HUI by demographic, socioeconomic, health behaviour, and health care variables using Ordinary Least Squares. We estimate unfair HUI by standardizing fairness, removing the fair component from the observed HUI. We consider health inequality due to factors amenable to policy intervention as unfair. We contrast estimates of inequity using two fairness-standardization methods: direct (considering unexplained inequality as ethically acceptable) and indirect (considering unexplained inequality as unfair). We use the Gini coefficient to quantify inequity.
resultsOur analysis shows that about 75% of the variation in the observed HUI is unexplained by the model. The direct standardization results in a smaller inequity estimate (about 60% of health inequality is inequitable) than the indirect standardization (almost all inequality is inequitable).
conclusionsThe choice of the fairness-standardization method is ethical and influences the empirical health inequity results considerably. More debate and analysis is necessary regarding which treatment of the unexplained inequality has the stronger foundation in equity considerations.
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